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Responsible for the management and communication of denials/appeals received from third party payers, managed care companies, and/or government entities/auditors related to medical necessity and/or level of care.
$33.3 - $44.49 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required.
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Apply appropriate clinical criteria/guidelines, policy, procedures and clinical judgment to issue appeals disposition and provide recommendations to a Medical Director.
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Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.
$200ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Areas of oversight for this position include, but are not limited to, case management, quality management, utilization management (UM), and grievance and appeals and committee participation.
$115.71 - $159.1 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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May also engage in grievance and appeals reviews. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.
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Grievance and Appeals - the Plan CMO maintains an active liaison with UCS G&A and is responsible for representing the Local C&S plan at State Fair Hearings. Growth - This medical director delivers the clinical value proposition focused on quality, affordability, and service, in support of growth activities of the C&S Health Plan and the plan CMO reviews and edits communications materials as required and represents the voice of the market-based customer in program design.
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If the answer is yes, the Division of Legal Services, Special Litigation and Appeals Unit is looking for its next Deputy Unit Director (Assistant Attorney General-Supervisor). Under general supervision of the Special Litigation and Appeals Unit Director (assistant attorney general - management), the Deputy Unit Director position provides a variety of legal services, both consulting and representation, to state agencies, agency heads, employees, the governor, and judges.
$45 - $55.26 an hourFull-timeExpandApply NowActive JobUpdated 25 days ago - UpvoteDownvoteShare Job
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The Associate Director reports to the Director of Corporate and Foundation Relations (Director of CFR) and will support and direct activities to increase corporate, foundation and individual giving to meet the fundraising and strategic goals of California State University San Marcos (CSUSM.
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Under the direction of the Director of Alumni Relations and the Director of Annual Giving, the Associate Director plans and implements a variety of community-building, educational and professional programs to successfully connect students, recent graduates and the greater alumni population for the College of Arts & Sciences, Sawyer Business School and Suffolk Law School.
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Proven direct fundraising success, including donor cultivation, grant writing, annual fund appeals, and membership development. Works closely with the Senior Director of Preservation Architecture (Graham Gund Architect) to develop and monitor major repair or capital projects and ensure the maintenance staff’s work program is aligned with preservation standards.
$110,000 - $120,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Two to three (2-3) years of experience in health plan, medical group or hospital utilization management position involving utilization, appeals and grievance, and retrospective review.
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Collaborates with AVP of Annual Giving and Membership, Director of Charter Membership, and direct mail vendors to integrate direct mail strategies to acquire new Patriots Circle Members, including production of solicitation appeals for Patriots Circle Membership.
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The Deputy Director, Development will lead the Museum’s Development team of twenty staff members, including the following direct reports: the Associate Director, Individual Giving, the Associate Director, Foundation & Government Relations, the Associate Director, Membership, the Assoicate Director, Events, and Manager, Corporate Giving.
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The Department of Surgery, Transplant Lab has an exciting open-rank clinical faculty position for an Associate Medical Director of our Transplant Laboratory. The associate director will work under the supervision of the interim medical director with potential opportunity to grow into Medical Director of Transplant Laboratory.
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associate director grievance and appeals jobs Title: medical director in Layton, Utah
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